“We were struggling to get our arms around our clinical and financial data to clearly see how our CDI program worked as a whole. We needed to make the data actionable. We wanted to be a five-star-rated quality hospital by CMS standards,” says Nathan Stutte, CFO at Sheridan Memorial Hospital. “To do that, we needed better ways to capture the patient story in real time. We went back to 3M for the software tools and coaching we needed to revitalize our CDI program.”
Robbi Morris, CDI coordinator for Sheridan, was hired specifically to lead the renewed CDI effort. “Our hospital was falling short of the state averages for risk of mortality and severity of illness,” Morris says. “We needed consistent reporting and dashboards to track case mix and financial impact. We needed a more collaborative workflow to structure our efforts and accurately capture patient encounters.”
“The shared workflow that 3M 360 Encompass provides has made it much easier to collaborate concurrently, before the patient is discharged,” says Shauna Laffitte, health information and records manager at Sheridan. “We’ve seen much more real-time collaboration between the CDI and coding teams, which were too segmented in the past. Now we can marry the expertise of these two teams. Training from 3M CDI experts has also been fundamental to driving our team’s collaboration.”
“The 3M 360 Encompass System as well as coaching and quarterly reports from 3M experts help us translate high-level goals into daily tasks we can achieve,” Morris adds. “We see where we fall short of peer benchmarks. We can track case-by-case, every encounter we query, to make sure we capture the baseline DRG and watch where the DRG moves after our queries. We now track financial query impact by medical DRG and surgical DRG. We can also track individual physicians and encounters.”
“We’re not only looking at CCs and MCCs, but ensuring DRGs reflect true complexity—such as a simple pneumonia that should be respiratory infection and inflammation. Our highest goal is to capture what’s right and true in each patient encounter. Working with 3M experts has helped our teams refine their CDI and coding skills. 3M has given us a common language and an integrated set of tools to pursue this goal,” Morris says.
With a new workflow structure in place, Sheridan can now zero in on specific priorities. “We’re now able to bring a CDI team together and say, ‘We need to focus on heart failure mortality or sepsis or debridement,’ and then take specific steps to improve results,” says Stutte.
Laffitte also cites the importance of 3M working directly with hospital administration and physicians to get buy-in. “Having our administration on board is pretty much everything,” she says. “Sheridan Memorial Hospital cultivates a culture of kindness and the physicians live it, every day. We had physician buy-in on day one. 3M helped us get administration buy-in, too.”
Sheridan Hospital’s CDI efforts are paying off. The case mix index has improved by 7.5 percent overall. The organization has seen more than a million dollars in financial improvement during 2017 and 2018, and the MCC/CC capture rates have met or exceeded the MEDPAR 80th percentile in five of eight categories. Heart failure numbers have improved in terms of severity of illness and risk of mortality compared to state benchmark levels before the program started. The severity-of-illness rate has improved 16.2 percent, and risk of mortality has been reduced by 41 percent compared to expected levels.
“These are solid results, especially when you consider our facility size and the range of services we provide to a rural patient population,” says Stutte. “When you document cases with precision and you get patients placed into the right DRG, the financial benefits follow. We have been recognized several times in the Top 100 Rural Hospitals list. Our ability to track our performance and capture the patient story in context contributes to that.”
“We’re also exploring new opportunities with payers because we now have the data we need to show where our quality outcomes really are. For example, we can look closer at something like COPD risk of mortality. Before the CDI program, we saw a lot of moderate risk of mortality that didn’t accurately reflect what was happening with our patient population. The data in recent years shows many more major and extreme cases of COPD.”
“We’re also looking at Blue Distinction Centers around spine, total knees and hips. This wouldn’t be possible if we didn’t have clear sight on patient encounters, which this advanced CDI program helps us achieve. We couldn’t do this if our CDI and coding teams were not collaborating and working sideby-side with physicians to capture the true patient story. This kind of effort sends a strong message to the community about our commitment to quality,” says Stutte.
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